Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 07063 | Date 03/12/2019 |
| Token No | SM/19-20/14611 03/12/2019 | Serial | 094 Last Visit: 14/12/2019 |
| Patient Name | Mr. ROHAN DEY | Contact No | 9051882757 |
| Address | 29(2/A) CHATRA GODAR BAGAN G.T ROAD, BAIDYBATI(M) | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||